Do We Really Know the CvLPRIT in Myocardial Infarction? Or Just Stent All Lesions?∗
| Autor: | Deepak L. Bhatt |
|---|---|
| Jazyk: | angličtina |
| Předmět: |
Male
FFR fractional flow reserve medicine.medical_specialty acute coronary syndrome(s) Myocardial revascularization medicine.medical_treatment Myocardial Infarction MPS myocardial perfusion scintigraphy MACE major adverse cardiac event(s) HF heart failure IRA infarct-related artery Culprit lesion Angioplasty Internal medicine medicine Humans non-infarct-related lesion primary percutaneous coronary angioplasty cardiovascular diseases Myocardial infarction P-PCI primary percutaneous coronary intervention Original Investigation business.industry complete revascularization percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction Stent Percutaneous coronary intervention angioplasty medicine.disease surgical procedures operative myocardial revascularization N-IRA non–infarct-related artery Conventional PCI MI myocardial infarction Cardiology Female business Cardiology and Cardiovascular Medicine PCI percutaneous coronary intervention |
| Zdroj: | Journal of the American College of Cardiology |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2014.12.037 |
| Popis: | Background The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain. Objectives CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only. Methods After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months. Results Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups. Conclusions In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival. (Complete Versus Lesion-only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605) |
| Databáze: | OpenAIRE |
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